A commentary on rabbinic texts and toxicality

June 30, 2005

Spurious correlations re: thimerosal vaccines and Sabbath law

With articles by the New York Times, CNN, and RF Kennedy Jr. [1], people keep asking whether autism is triggered by vaccines with mercury-based thimerosal. Here's a partial reading of the debate from a Jewish standpoint.

The debate about vaccines and autism requires us to judge correlations. For instance, does the onset of autism correlate to thimerosal vaccinations? More importantly, does the incidence of autism rise and fall with the level of mercury-based vaccinations in a population? Maybe there's data to support these correlations.

But are these spurious correlations between thimerosal and autism? Unfortunately, the question of spurious correlation is tough to answer. We lack adequate biochemical (etc.) knowledge of how mercury effects the spectrum of autism(s). [2] It’s also difficult to identify and eliminate other triggers (besides vaccines) of autism(s). Furthermore, epidemiological correlations are hard to substantiate because we are not running a controlled experiment on human children.

Instead, critics might say we are running a massive uncontrolled experiment with thimerosal. Keep in mind, though, that there is an enormous health benefit associated with vaccines. Fortunately, thimerosal has been eliminated from some vaccines. Yet, policymakers are continuing with the virtual experiment with mercury-tinged vaccines because these are still the best vaccines for the flu. (And influenza is a serious health threat, as you can see by checking the spanking new wiki flu website set up by Effect Measure and friends.)

Turning now to my Talmudic daf yomi readings. To a modern reader, the rabbis are dealing with a problem of correlation: do amulets protect the health of animals? (bShab 53b) If amulets truly correlate with health, then they may be carried on Shabbat. If amulets do not work (= if amulets and health are a spurious correlation), then carrying them is a form of prohibited sabbatical work.

Lacking biochemical (etc.) knowledge of sickness, the rabbis judged the efficacy of amulets by two critera (bShab 61): medical efficacy and expertise. First, amulets are deemed effective if they cure or prevent sickness three times (3x); Second, healers are deemed experts if their amulets cure three times (3x). Wisely, the rabbis did not assume that amulets that cured humans would necessarily work with animals. [3]

By these Talmudic criteria, one might be inclined to approve thimerosal vaccines. Vaccines prevent diseases at a high rate. Conversely, there are scanty correlations to argue that thimerosal vaccines cause autism. Furthermore, the scientists who proclaim that thimerosal is linked to autism are vastly outweighed (in number and reputation) those scientists who question the alleged link to autism. (see, e.g., Autism Diva on Geiers, Orac on Kirby) Looking at the quality of experts and the data, one might expect Jewish law (halakhah) to favor the use of thimerosal vaccines.

However, these Talmudic criteria may not be sufficient. After all, Jewish law here judges amulets only in terms of Shabbat. The downside to poor judgment on an amulet was small. With a mercury-based vaccine, the downside to poor judgment might be an increased incidence (but not an epidemic) of autism. Or unvaccinated exposure to disease. Furthermore, there is the hermercurial factor: Kennedy is right that the pharmaceutical industry is investing well in Bill Frist and other politicians. It would be best if we could avoid the thimerosal choice altogether.

Therefore, with so much at stake, there are forceful reasons to find/fund alternative vaccines and public health measures to tackle flu and the remaining diseases now fought with mercury-derived vaccines. Plus, the precautionary reduction in U.S. and Eurpoean thimerosal use should be applied to Third World countries, too. Meanwhile, in Jewish communities, let's think about vaccination decisions by parents and the needs of autistic children (cp. programs in Balitmore MD and Newton, Mass.). Kol tuv,

[3] Starting with the gemara at bShab 61a-b, Talmudists apply the 3x criteria with permutations involving 3 different amulets, diseases, patients, or healers. Unwisely, some drugs have been marketed to humans based merely on animal testing results. Prime example: thalidomide.

Comments

Have you already written on the Jewish law and the way society should feel toward individuals who don't fit, through no fault of their own, particularly the autistics and the "retarded"?

I feel that the moral thing is to treasure these people and not hold them out as moral or mental failures and culls and waste. It's very unfortunate that some parents have painted their children as such in order to draw attention to their needs.

"Over the top" scarcely covers their descriptions. The children absolutely are aware of these descriptions, too, as are autistic adults, even if they seem to be unaware.

"Have you already written on the Jewish law and the way society should feel toward individuals who don't fit, through no fault of their own, particularly the autistics and the "retarded"? I feel that the moral thing is to treasure these people…”

Some scholars (e.g., J. David Bleich, Tzvi Marx) have written about pre-modern Jewish law concerning the deaf-mute, which is a problematic pre-cursor for current Jewish legal and ethical approaches. I haven’t written (yet?), but we can start putting some sources and links here. For instance: "Local parents cry out for special-needs kids' services" (in Calif.)

BS"D
This is a terrific post! Thank you for sharing your wisdom in these matters, Kaspit. I am about to embark on Melitz Yosher training in order to better my amulet-making craft, so I will keep your writings in mind.
I'm also going to link to your blog today, bli neder :)

i was once told that later rabbis (rishonim - i forget which) use this as a springboard to discuss exactly how we know when something 'yesh bo mishum refuah.'

anyway, as for the quote above one quick point:

i don't think that the rabbis saw hillul shabbat as a "small" downside. (note that the rabbis required a special logic that saving someone now allows her to keep future sabbaths in order to allow life-saving medical procedures that violate shabbat). especially if the potential prohibition involved is biblical (or is it rabbinic?).

The principle about medical effect (yesh bo mishum refu'ah) does seem to be a focal point of debate among rishonim. Rambam and Meiri apparently are among the most skeptical and disapproving of practices that are not rationally proven. I gather that a more Da'as Torah position would believe that the Talmudic sages could not have erred in their judgment of the efficacy of amulets, incantations, etc. So people on different sides of the Slifkin debate would disagree sharply about these sugiyot (passages at e.g., Shab 53,67).

You are also right that the rabbis take hillul shabbat very seriously. Still, if the Talmudic criteria are insufficient, then somebody is wearing an amulet that was approved by the Sages based on a spurious correlation. For the Rabbis, this is a kind of a judicial error. For one wearing the erroneously approved amulet, I would guess it's categorized as a completely inadvertent transgression (shogeg gamur. What do you think?

Ineffective amulets* are forbidden by rabbinic decree and d'rabbanan, not Biblical, prohibitions. (I.e., Biblically ok if worn, but problem if they are taken off, dropped, etc.) Furthermore, at least by the rishonim, we realize that all this wearing occurs in a karmelit (less than public domain), so there's no transgression anyway. (See last Tosafot 64b)

Kol tuv, Kaspit

* My post considered written amulets (e.g. daf 61) as a shabbos violation. You properly note that some other amulets (incantations, etc) may be forbidden due to darkhei emori.